tetano
Editor, Senior Moderator
J Clin Virol
. 2020 May 15;104444.
doi: 10.1016/j.jcv.2020.104444. Online ahead of print.
Profiling COVID-19 Pneumonia Progressing Into the Cytokine Storm Syndrome: Results From a Single Italian Centre Study on Tocilizumab Versus Standard of Care
Luca Quartuccio[SUP] 1 [/SUP], Arianna Sonaglia[SUP] 1 [/SUP], Dennis McGonagle[SUP] 2 [/SUP], Martina Fabris[SUP] 3 [/SUP], Maddalena Peghin[SUP] 4 [/SUP], Davide Pecori[SUP] 4 [/SUP], Amato De Monte[SUP] 4 [/SUP], Tiziana Bove[SUP] 5 6 [/SUP], Francesco Curcio[SUP] 2 [/SUP], Flavio Bassi[SUP] 5 [/SUP], Salvatore De Vita[SUP] 1 [/SUP], Carlo Tascini[SUP] 4 [/SUP]
Affiliations
Abstract
Objective: Approximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or "cytokine storm". Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point.
Methods: Between February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC).
Results: In the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were 3 deaths (17.8 ? 10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and 1 serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p < 0.0001 for both) and higher neutrophils and lower lymphocyte levels (p = 0.04 and p = 0.001, respectively) with the TOCI ventilated patients having higher markers than non-ventilated TOCI patients.
Conclusion: Higher inflammatory markers, more infections and worse outcomes characterized ventilated TOCI cases compared to ward based TOCI. Despite the confounding factors, this suggests that therapy time in anti-cytokine randomized trials will be key.
Keywords: COVID-19; coronavirus; cytokine; intensive care; tocilizumab.
. 2020 May 15;104444.
doi: 10.1016/j.jcv.2020.104444. Online ahead of print.
Profiling COVID-19 Pneumonia Progressing Into the Cytokine Storm Syndrome: Results From a Single Italian Centre Study on Tocilizumab Versus Standard of Care
Luca Quartuccio[SUP] 1 [/SUP], Arianna Sonaglia[SUP] 1 [/SUP], Dennis McGonagle[SUP] 2 [/SUP], Martina Fabris[SUP] 3 [/SUP], Maddalena Peghin[SUP] 4 [/SUP], Davide Pecori[SUP] 4 [/SUP], Amato De Monte[SUP] 4 [/SUP], Tiziana Bove[SUP] 5 6 [/SUP], Francesco Curcio[SUP] 2 [/SUP], Flavio Bassi[SUP] 5 [/SUP], Salvatore De Vita[SUP] 1 [/SUP], Carlo Tascini[SUP] 4 [/SUP]
Affiliations
- PMID: 32425662
- PMCID: PMC7227535
- DOI: 10.1016/j.jcv.2020.104444
Abstract
Objective: Approximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or "cytokine storm". Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point.
Methods: Between February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC).
Results: In the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were 3 deaths (17.8 ? 10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and 1 serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p < 0.0001 for both) and higher neutrophils and lower lymphocyte levels (p = 0.04 and p = 0.001, respectively) with the TOCI ventilated patients having higher markers than non-ventilated TOCI patients.
Conclusion: Higher inflammatory markers, more infections and worse outcomes characterized ventilated TOCI cases compared to ward based TOCI. Despite the confounding factors, this suggests that therapy time in anti-cytokine randomized trials will be key.
Keywords: COVID-19; coronavirus; cytokine; intensive care; tocilizumab.